Training package questionnaire

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TRAINING QUESTIONNAIRE

* Indicates required field

Email *

Name *

First

Last

Phone Number *

I am a Military, LE, or First Responder *

Yes No

Age *

State *

Height *

Weight *

How many times a week do you train on average? *

Once per week 2 to 3x week 4x per week 5x per week 6x per week

How many years have you been training? *

Less than 1 year 1 - 2 years 3 - 5 years 6 - 10 years More than 10 years

What are your specific training goals? *

How many hours do you sleep each night on average? *

How would you rate your daily nutrition/diet quality? *

Poor Could be better Good Great

Do you have intentions of competing within the next year? *

Yes No Maybe

What are your current Squat, Bench, and Deadlift PRs? *

What's your best availability to meet with a coach? *

What is your athletic background? Sports? *

Do you have any previous injuries that could affect training? *

Yes No

If Yes, please indicate injury and severity below. *

How did you hear about me? *

Instagram Facebook Internet Search Advertisement Friend YouTube Other

If Other, please specify. *

Were you referred by a current client? *

Yes No

If yes, who? *

***LIABILITY RELEASE STATEMENT***
I ACKNOWLEDGE THAT I AM CURRENTLY HEALTHY ENOUGH TO PARTICIPATE IN PHYSICAL ACTIVITY AND UNDERSTAND THAT THE COACH, COLLIN WHITNEY, OR WHITNEY STRENGTH & PERFORMANCE LLC WILL NOT BE LIABLE FOR ANY INJURY THAT MAY OCCUR DURING A TRAINING PROGRAM, PERSONAL TRAINING SESSION, OR UPCOMING MEET(S)/EVENT(S) DURING OR AFTER COMPLETION OF A SESSION OR PROGRAM.

Please indicate that you understand and agree to the Liability Statement by e-signing below. *

I agree to comply with the Liability Release Statement above.

Signature *

Date *

Submit

FAQ | Terms Of Agreement

Home
About
PWRBLD Online
- PWRBLD Account
Training
Shop
- PWRBLD Merch
Testimonials
Contact Me
Personal Training